Gynecology services provided:
- Preventive health care
- Annual breast and pelvic examinations
- Pap smears
- Treatment of pelvic and vaginal
- Contraception and Sterilization
- Family planning and counseling
- Screening for and treating sexually
- Evaluation and treatment of premenstrual
- Infertility evaluation
- Adolescent gynecology
- Urogynecology - evaluation of uncontrolled
- Menopause and post reproductive
- Osteoporosis testing
- Cancer testing
- Gynecology procedures
- Endometrial Ablation
- FirstCyte Ductal Lavage
- Dilation and Curettage (D&C)
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- Pre-natal testing
- Non-stress testing
- Abdominal and transvaginal
- Fetal heart monitoring
- References for prenatal
- References for breastfeeding
- Any special conditions
- Delivery of your baby
- Follow-up care after
- High risk pregnancies
- Management of pre-term labor
- High blood pressure
- Multiple pregnancies
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for the Female Reproductive Organs. Laparoscopy is used to
detect and treat many reproductive organ problems such as
unexplained vaginal bleeding or pelvic pain. This type of
surgery gives Dr. Cardenas a clear view of your internal organs.
How does it work?
Laparoscopy uses a long,
slender tool called a laparoscope. Dr. Cardenas will insert
this scope and other surgical tools through a small incision.
The incision is made in the abdomen (lower belly). A tiny
camera is attached to the laparoscope, which sends light into
the body. Dr. Cardenas then sees the reproductive organs on
a monitor, much like a TV screen. He can turn the laparoscope
to look at these organs from all angles.
Your reproductive anatomy:
By learning how your reproductive
organs function, you can better understand what Dr. Cardenas
sees during Laparoscopy. During each menstrual cycle, changes
take place in these organs to prepare your body for a possible
pregnancy. After menopause, these cyclic changes no longer
Why laparoscopy is
It gives Dr. Cardenas
a direct view of your reproductive organs.
This can help him diagnose
a problem or find whats causing your symptoms. Treatment
is sometimes part of the same surgery. Laparoscopy is sometimes
used for certain other reproductive surgeries. Listed below
are some common procedures:
used to help relieve pain or stop heavy menstrual bleeding,
also it can help restore fertility. Dr. Cardenas destroys
or removes some or all of the abnormal tissue. Special instruments
such as lasers, ultrasonic tools, or electrosurgical tools
may be used.
- Adhesions Finding
and removing adhesions can help to relieve your pain. Dr.
Cardenas cuts the adhesions and frees structures that had
been bound by the scar tissue; also it can help restore
fertility. Special instruments such as surgical scissors,
lasers, ultrasonic tools, or electrosurgical tools may be
A means to find out why you are infertile (having a hard
time becoming pregnant). Some common causes are blocked
fallopian tubes, endometriosis, and adhesions. This procedure
may restore your fertility. Sometimes a blocked fallopian
tube can be repaired through the laparoscope. Dr. Cardenas
may do this with microsurgery (where tiny surgical tools
are used to gently handle tissue).
- Ectopic Pregnancy
used to remove the fetal tissue lodged in the fallopian
tube. Dr. Cardenas can clear the tube and control any bleeding,
and sometimes all or part of the affected fallopian tube
can be removed. Special instruments are used such as lasers
or electrosurgical tools.
- Ovarian Cysts or Tumors used
to remove cysts or tumors depending on the size of growth
found, your age, and whether you still plan to have children.
If you have a cyst, Dr. Cardenas may drain it with a small
needle. The cyst or tumor and, in some cases, the ovary
may have to be removed. This is done with surgical scissors,
lasers, ultrasonic tools, or electrosurgical tools.
- Fibroids used to remove growth
from inside the uterine space or within the uterine walls.
The can also be found attached to the outside of the uterus.
Removing fibroids can help relieve severe cramping or heavy
menstrual bleeding. Special surgical tools are used and
the method used depends on the size, number and location
of the fibroids.
- Tubal Ligation used to prevent
pregnancy. Dr. Cardenas can seal off each fallopian tube
by using a ring, an elastic band, or a clip. Also the tubes
can be burned closed with electrical energy. This technique
can keep the sperm from fertilizing the egg.
Before your laparoscopy:
If you are having a Laparoscopy,
it helps to know what to expect. Understand the procedure;
ask Dr. Cardenas all of your questions. Know what your insurance
carrier covers and what your financial responsibility is.
Follow any instructions given by your surgery coordinator
and hand carry any written orders from Dr. Cardenas to the
healthcare facility. This will help make sure your procedure
Preparing for surgery:
Prepare for surgery as
instructed by your surgery coordinator. Be sure to:
- Have any laboratory
or diagnostic test ordered by Dr. Cardenas.
- Avoid taking aspirin or ibuprofen
1 to 2 weeks prior to the surgery. Ask Dr. Cardenas whether
you can take routine medications.
- Stop smoking. This will help prevent
risks during and after surgery.
- Arrange for a ride home after surgery.
- Stop eating or drinking after midnight
before surgery. This includes water, coffee, candy, and
Arriving for surgery:
On the day of surgery,
arrive at the healthcare facility as directed by your surgery
coordinator. Arriving on time will help prevent delays. You
will need to sign a consent form stating that the procedure
has been explained to you. If you dont understand certain
parts of the form, ask for help.
Learning about the
Before surgery, you will
meet the anesthesiologist to discuss the type of anesthesia
you will be given prior to surgery. This medication helps
you sleep during the surgery.
How laparoscopy is
After you are given the
anesthesia, small incisions are made in your abdomen. This
way, the laparoscope and other surgical tools can be inserted
to perform the procedure.
A closer look:
Dr. Cardenas needs to
be able to see your reproductive organs clearly during surgery.
Therefore, your abdomen is inflated with carbon dioxide gas
or another type of gas. Sometimes, a device is inserted in
the vagina to lift the uterus. This helps Dr. Cardenas see
your organs better on the monitor (TV screen).
In the operating room,
you will lie down on a special table, which may be tilted
to help Dr. Cardenas reach your reproductive organs. An IV
(intravenous) line will be started by the nursing staff or
assistants to give you the medications and fluids necessary
during and after your surgery. Once the anesthesia is given,
your abdomen is inflated with gas and incisions are made.
Dr. Cardenas then inserts the laparoscope and other surgical
tools. At the end of surgery, the gas is released and the
incisions are closed.
Dr. Cardenas may make
your incisions near the navel (belly button), the waistline
or the pubic hairline. Most often, each incision is about
a half-inch long. It is sometimes necessary for extra incisions.
If a procedure cant be done through the laparoscope,
Dr. Cardenas may need to make a larger incision.
Recovering in the hospital:
It is normal to be drowsy
or have some nausea when you wake from your surgery and you
may spend a few hours in the recovery room. Your family will
be able to visit.
You may have a catheter
(small tube) to drain your bladder. The catheter will be removed
before your go home.
Risks and complications
Dr. Cardenas will explain
the possible risks and complications of laparoscopy surgery
during your office visits. Some of the complications include
- Risks of anesthesia
- Damage to blood vessels, nerves,
muscles, or nearby pelvic structures (the bladder, ureters,
- Blood clots
- The need for a larger incision
You may go home the same
day of your surgery, or you may have to stay in the healthcare
facility over night. Dr. Cardenas will determine your length
of stay after your surgery and give you advice to help your
body heal. Please follow all instructions to ensure you heal
When Dr. Cardenas releases
you from the healthcare facility, please have a family member
drive you home and call Dr. Cardenas if you have any of the
- Chills, or a fever of 101F or higher
- Heavy, bright-red vaginal bleeding
or smelly discharge
- Difficulty urinating
- Severe abdominal pain or swelling
- Leg pain, redness, or swelling
- Nausea or vomiting
Let Dr. Cardenas know
if something about your health does not seem normal, or if
you have any questions or concerns.
Becoming active again:
You will get back to a
normal routine after your surgery, however you may need to
rest for a few days or longer. Little by little, build up
to your normal activities. Check with Dr. Cardenas prior to
any vigorous exercise or driving. Please do not drive while
taking pain medication.
Dr. Cardenas will inform
you when to follow-up with an office visit. This could be
a few days to a few weeks after your surgery. Be sure to schedule
any follow-up visits requested in order to monitor your recovery.
When following the advice given, you will find yourself feeling
better and enjoying life more.
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If Dr. Cardenas has recommended
that you have hysteroscopy, a procedure that allows a view
directly inside your uterus. Hysteroscopy is done without
incisions and causes little discomfort. It can help him identify
the causes of uterine problems. It can also be used to treat
some of the following problems.
Hysteroscopy is commonly
done to determine the cause of unusually heavy or long periods,
bleeding between periods, or postmenopausal bleeding. In certain
situations, it may be done to evaluate the cause of severe
menstrual cramps. Also, hysteroscopy may sometimes be used
to check for causes of infertility or the inability to carry
pregnancies to term.
Two uses of hysteroscopy
Hysteroscopy can be used
in two ways. To look inside the uterus for problems such as
abnormal growths, Dr. Cardenas may perform diagnostic hysteroscopy.
If growths or other problems are found, he may remove them
during operative hysteroscopy.
The tools that Dr. Cardenas
uses to perform hysteroscopy include:
- A hysteroscopy (a long, thin telescope)
that lets him see inside your uterus, by looking directly
through the hysteroscope or at images of your uterus on
a video monitor.
- A speculum (the same instrument
used during a Pap smear) that gently widens your vagina.
The cervix (opening to the uterus) is sometimes widened
- Specially designed surgical instruments
that can be inserted through the hysteroscope to take tiny
samples of the uterine lining or remove growths.
During diagnostic hysteroscopy,
Dr. Cardenas examines the inside of your uterus. If growths,
scar tissue, or other problems are found, he can use the information
gathered during the procedure to develop a plan for treatment,
Diagnostic hysteroscopy may be done in your Dr. Cardenas office,
an outpatient clinic or a hospital.
Before the procedure
Ask Dr. Cardenas whether
you can take a medication like ibuprofen an hour before your
procedure. This medication can help lessen the uterine cramps
that sometimes occur during hysteroscopy. Before the procedure,
you may be asked to fill out some forms. Then youll
change into a gown and lie on an examination table with you
feet in stirrups.
During the procedure
To lessen discomfort,
Dr. Cardenas may numb your cervix (local anesthesia). If the
procedure is done in a hospital, your body may be numbed below
the waist (regional anesthesia), or you may be completely
asleep (general anesthesia). Your cervix may be gently widened.
The hysteroscopy is then inserted. If a video camera is used,
you may be able to watch the procedure on the video monitor.
After the procedure
and bleeding are common for about 24 hours after the procedure,
so wear an absorbent pad. Youll need to avoid tampons
and sexual intercourse for a brief time. Please check with
Dr. Cardenas on how long to avoid both.
What your physician
During diagnostic hysteroscopy,
Dr. Cardenas looks inside your uterus for anything abnormal.
Fibroids, polyps, and adhesions are common problems that may
be seen during hysteroscopy. Uterine cancer and hyperplasis
(an overgrowth of the uterine lining) are not common, but
may be found with hysteroscopy if either is present. During
the procedure, a small sample (biopsy) of the uterine lining
may be taken for later laboratory evaluation. If you have
a "lost" intrauterine device (IUD), it can found
Procedures that may
- Dilation and Curettage (D&C)
Excess blood and tissue are carefully scraped off
the uterine wall.
- Fibroid Removing fibroids
can help solve problems with abnormal bleeding or discomfort.
- Polyp Removing a polyp can
help stop or lessen abnormal bleeding.
- Ablating the Endometrium
Removing or destroying the entire lining of the uterus.
After this procedure is performed, pregnancy is rare and
carrying a pregnancy to term is no longer possible.
- Adhesions or a Septum Removing
these growths can help restore fertility and the ability
to carry a pregnancy to term.
Getting on with your
To get the best results
from your hysteroscopy, follow Dr. Cardenas instructions and
keep all of your follow-up appointments. By helping with the
diagnosis and treatment of uterine problems, hysteroscopy
can provide the peace of mind you may need to get on with
life and back to activities you enjoy.
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Are you dealing with severe
menstrual bleeding, a pelvic infection, or pain? Or, have
you been diagnosed with a type of cancer. For these or other
reasons, Dr. Cardenas may have suggested that you have a hysterectomy
(surgery to remove the uterus). A hysterectomy can relieve
symptoms and stop infection. And if you have cancer, it may
save your life. Still, making a decision about surgery can
be hard. Reading the following information can help.
For years, hysterectomy
was the only treatment for women with serious reproductive
health problems. Today there are often other options. Discuss
your treatment plan with Dr. Cardenas as well as any other
health problems such as heart disease or diabetes. He will
suggest hysterectomy only if it is the best treatment for
Problems that hysterectomy
Problems with any of the
reproductive organs can disrupt your cycle, cause symptoms,
or threaten your health. Some of the most common problems
- Endometriosis when tissue
that should line the uterus grows outside of the uterus.
Scar tissue (adhesions), sever pain, and excess bleeding
- Fibroids Benign (noncancerous)
tumors. They grow in the uterus. Fibroids can cause heavy
periods, pain and pressure in the pelvic area, and urinary
- Pelvic relaxation when certain
ligaments weaken. This can cause the bladder, rectum, or
uterus to drop (prolapse). Urinary leakage and pelvic pressure
or discomfort may result.
- Cancer presence of malignant
(cancerous) tumors. It can occur in the uterus, cervix,
ovaries, or tubes. Some tumors cause abnormal bleeding.
Others cause no early symptoms at all.
A hysterectomy may also
be done for other reasons as well.
You may be asked to have
one or more tests. Their results may help find the cause or
extent of your problem. Here are some of the most common tests:
- A Pap test tissue samples
from your cervix and vagina. The samples are checked for
- Ultrasound Sound waves are
used to produce pictures of your organs. These pictures
can show abnormal growths. During the test, a probe may
be placed on your abdomen. Or, a probe may be gently inserted
into your vagina.
- Endometrial biopsy a sample
of the tissue lining your uterus. The sample is checked
for abnormal cells.
- Hysteroscopy A long, lighted
tube is inserted through your vagina. This allows Dr. Cardenas
to see inside your uterus. He will check for fibroids and
- D&C (dilatation and curettage)
The lining is removed from your uterus. It is checked
for any abnormal cells.
- Laparoscopy A thin, lighted
tube is inserted through a tiny incision in your abdomen.
This allows Dr. Cardenas to check your pelvic organs for
endometriosis and other problems.
Planning your treatment
After going over the results
of your exam and any tests, you and Dr. Cardenas will make
a treatment plan. Options may include hysterectomy by itself
or along with other treatments. As you create the plan, Dr.
Cardenas may discuss the following questions with you:
- How severe is your problem?
Is your health problem getting in the way of your daily
life? Is the problem getting worse? If your answers are
"no" treatment other than hysterectomy may be
- Do you want to have children?
If you do, Dr. Cardenas may discuss other types of treatment.
- Should the ovaries be removed too?
This may be discussed if you have cancer or are at
an increased risk for cancer. In such cases, Dr. Cardenas
may suggest removing the ovaries and fallopian tubes along
with the uterus. If the ovaries are to be removed, talk
to Dr. Cardenas before the surgery about hormone replacement
The surgical procedure
Before the surgery, you
and Dr. Cardenas will discuss how the uterus will be reached.
You will also talk about the type of hysterectomy you will
have. You may have only your uterus removed. Or, your ovaries
and fallopian tubes may be removed as well.
Reaching the uterus
The uterus can be reached
and removed in three ways. In many cases, the approach depends
on your health problem.
- Abdominal Hysterectomy a
4 to 6 inch incision is made in the abdomen. The incision
can be horizontal (side-to-side) or vertical (up and down).
The uterus is removed through the incision. This procedure
is done as an inpatient (in the hospital) only. A abdominal
incision will leave a scar on the abdomen depending on the
location of your problem.
- Vaginal Hysterectomy An incision
is made inside the vagina. The uterus is then removed through
the vagina. This can be done if the uterus is not too large,
or if it has dropped down into the vagina. This procedure
may be done as outpatient in a surgery center or 23 hour
stay facility. A vaginal incision leaves no scar on the
- LAVH (laparoscopically assisted
vaginal hysterectomy) uses small incisions in the abdomen.
A tiny camera and instruments are inserted to view and move
the organs. The uterus is removed through the vagina. Laparoscopic
incisions leave small scars on the abdomen that is hard
Preparing for surgery
In most cases, a hysterectomy
takes 1 to 3 hours. Knowing what to expect before and after
surgery can help reduce fears you may have. It also helps
you prepare. Be sure to follow any instructions Dr. Cardenas
Before the day of surgery
A few weeks before surgery
you may be asked to:
- Stop smoking.
- Donate your own blood. This is in
case you need to receive blood (a transfusion) during surgery.
As the day of surgery
grows closer, you may be asked to:
- Have blood, urine, and other tests.
- Stop taking certain medications.
- Sign a consent form for the surgery.
- Stop eating and drinking after the
midnight before surgery.
At the hospital
An intravenous (IV) line
may be used to provide fluids and medications, such as antibiotics.
During the hysterectomy, you will receive anesthesia to keep
Risks and complications
The risks and complications
of a hysterectomy include:
- Side effects from the anesthesia
- Bleeding, with a possible need for
- Damage to nearby organs
- Blood clots in the legs or lungs
What to expect after
You may spend up to a
few days in the hospital, if in-patient procedure. While there,
ask Dr. Cardenas or the nurse any questions you may have.
For the first days after surgery, here is what you can expect:
- The abdominal incision may be closed
with stitches or staples. It is covered with gauze. Any
staples may be removed during your hospital stay or at a
- Pain can be relieved with medication
prescribed by Dr. Cardenas.
- Urination may be aided by a tube
(catheter). It is put in yur bladder during surgery. In
most cases, it is taken out a day or two after surgery.
- Vaginal bleeding is likely. You
will need to use sanitary pads. Tampons should be avoided.
- Meals may be limited to liquids
until your bowels are back to normal.
- Your lungs need to be kept clear
of excess fluid. This prevents problems such as pneumonia.
You will be shown how to clear your lungs.
Recovery at home
Healing takes time. How
much time depends on your health and the type of surgery you
had. Expect it to take weeks before you feel really well.
Call Dr. Cardenas if you have any of the following:
- Fever or chills
- Heavy vaginal bleeding or smelly
- Redness, bleeding, or discharge
at the incision site.
- Pain or swelling in your legs.
- Shortness of breath or chest pain.
To help your body heal,
follow these tips:
- Take showers instead of baths.
- Use pads to absorb bleeding or discharge.
Light bleeding is likely at first, Brownish discharge may
appear for weeks.
- Do not use tampons or douches. They
can cause the vagina to become infected.
- Do not have sexual intercourse for
as long as Dr. Cardenas suggests, (most likely 6 to 8 weeks).
- To avoid constipation, eat fruits,
vegetables, and whole-grain foods. Drink at least 8 glasses
of fluid each day.
- Avoid tasks or movements that can
strain your incision, such as lifting or bending.
- Ask Dr. Cardenas when you can drive.
- The type of work or exercise you
do can affect your healing process, please discuss with
- Ask you family and friends how they
Take care of yourself
Having a hysterectomy
may affect your emotions. You may be relieved to no longer
have symptoms. But you may feel "down" about the
changes in your body. You may also have moods swings if your
ovaries were removed and you had not yet reached menopause.
To feel better, take any medications prescribed by Dr. Cardenas.
Looking forward to
Once you have healed from
surgery, you can focus on enjoying life. You may have more
energy, now that symptoms of severe pain and bleeding are
gone. To feel your best, follow Dr. Cardenas instructions,
eat right and exercise. And remember, even after a hysterectomy,
regular checkups are still needed.
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What Is Endometrial
It is the burning, or
ablation, of the endometrial lining of the uterus with a resectoscope
to control excessive or prolonged menstrual bleeding.
Who is a candidate
for the procedure
Women with prolonged and
excessive menstrual flow are often incapacitated or severely
restricted in their activities each month. Those suffering
from this problem are seen in the physicians office
frequently. Many will undergo multiple D&C (Dilatation
procedures, and try various
hormonal regimens to control the bleeding. When their condition
does not respond to this treatment, their physician often
recommends hysterectomy. In fact, 40% of all hysterectomies
are performed for this reason.
Endometrial ablation is
designed as an alternative to hysterectomy for women with
this condition. The goal is to induce total cessation of menstrual
flow and eliminate the need for major surgery. Other women
who might benefit are those with uterine fibroids and those
patients in need of surgery but classified as high risk because
of severe medical problems (cardiac, bleeding tendencies,
What are the advantages
of Endometrial Ablation
As opposed to hysterectomy,
endometrial ablation requires no surgical incision or organ
removal, and is a safe, cost-efficient procedure done as an
out-patient. The patients hormonal status remains unaffected.
Hysterectomy requires 5 7 days of hospitalization and
a 4 week recuperation period. Endometrial ablation patients
return home the same day of their procedure and can resume
most normal activities usually within 5 days. This makes endometrial
ablation ideal for working women unable to take extended disability
What happens during
You will be sedated under
general anesthesia. Your uterus is filled with a saline-like
fluid. Without making an incision, Dr. Cardenas inserts a
telescopic instrument called a hysteroscope through the vagina,
past the cervix, and into the uterus. The hysteroscope has
a camera and light source, which allows him to view the inside
of your uterus on a TV screen. Using a gyneresectoscope, he
methodically ablates or burns away the lining of the uterus.
This is the layer which is responsible for a womans
monthly period. Once the procedure is completed, you are taken
to the recovery area and allowed to rest. Most patients return
that same day to the comfort and convenience of their own
How long is the recuperation
Most patients rest with
only light activity for a day or two and can usually resume
their normal schedule in 5 days. Mild uterine cramping for
several days is usually all the discomfort you will experience.
An occasional aspirin or advil should relieve this.
Where will I have the
Almost all endometrial
ablations can be performed in an out-patient setting. The
surgery center has all the latest equipment necessary to perform
this procedure. Their nurses are specially trained to provide
you with a highly personalized and professional level of service.
What are the effects
of the procedures
By burning away the menstrual
lining of the uterus, endometrial ablation successfully eliminates
or greatly reduces monthly menstrual flow. In addition, women
have noted improvement in menstrual cramps and PMS symptoms,
which have often accompanied their heavy periods.
What if I am not a
candidate for endometrial ablation
Certain complicating factors,
such as the condition and size of your uterus, may preclude
endometrial ablation as possible therapy. The doctor will
then discuss other options of treatment for your condition.
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